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State officials worry that they would be left to police the solvency of health insurance companies while federal officials pressured insurers to reduce premiums, as Mr. Obama has done in recent days.

“You can’t separate the underlying solvency of companies from the rates they charge,” said Sean Dilweg, the insurance commissioner in Wisconsin. “The federal proposal would be a huge pre-emption of decisions that states have made over their history.”

…. Insurance commissioners said they fully supported efforts to expand coverage and rein in health costs. But they said it would be risky to hold down premiums before costs were under control. And they do not expect the federal legislation to drive down costs anytime soon.

Sandy Praeger of Kansas, one of several insurance commissioners who met with Mr. Obama at the White House last week, said: “From a consumer protection standpoint, the most important thing we do is ensure the solvency of companies. We would strenuously resist not having the ability to approve rates or having the commissioners’ oversight of rates overturned.”

“You are not necessarily helping the consumer if you keep rates artificially low,” Ms. Praeger said. “What’s worse for the consumer: having a premium increase or having to pay the full amount of a medical expense because the company is out of business?” [Emphases are mine.]

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